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Tuesday, August 26, 2014

Teaching Coping Skills

I covered
this topic a little in my Top Ten post, but coping skills are often a
skill deficit I see across many of my clients regardless of their age or
cognitive ability.

In the very
young clients this may look like a screaming tantrum, and in the older clients
it may look more like kicking holes in the walls of their home. The same issue
is fueling both outbursts: challenges with Emotional Regulation.

I find that
parents and teachers can often identify consequent strategies, or those
techniques they should apply once the problem behavior is occurring. It’s
identifying antecedent strategies, or ways to prevent the problem behavior that
many people don’t think of, or don’t plan for. This is usually reflected in the
kinds of questions I get asked, such as “What do we do when s/he does
(behavior)” and not “What can we do to prevent (behavior) from happening?”

Coping
skills teach the skills of self-management, labeling one’s own emotional state,
controlling impulses, engaging in thoughtful behavior, and making good choices.

Despite how
it may appear, most of these kiddos don’t go from “0-60” in the blink of an
eye. Emotions have been simmering inside and building, sometimes for hours,
sometimes for days, and what you or I may consider a harmless event can set the
child off. So to anyone observing, it would seem like the behavior came out of
nowhere. My verbal clients will often tell me about behavioral outbursts they
had, and something that happened sometimes days before the outburst was a
trigger. Maybe a kid at school called them a name, and they perseverated on
that for days before exploding at home when they were told to turn off a video
game.

Kiddos who
have difficulty regulating their emotional state are easily triggered. There
are many, many things that cause them to become frustrated, angry, or upset,
and sometimes these triggers change without warning. For example maybe Chris usually
gets upset when babies cry on TV, and then one day at the mall a baby in a
nearby stroller sets Chris off into a full meltdown.

It isn’t unusual that triggers grow, or
generalize, to the point where parents or teachers can spend the whole day
putting out behavioral fires or desperately trying to eliminate stressors from
the child’s environment (which in some settings, is nearly impossible to do).
This can put an incredible amount of stress on the caregivers.

If this is
something you are currently struggling with in your child or a student, let me
suggest approaching this problem in a different way. What if you could teach
the individual to identify when they have been triggered, to select an option
to de-escalate, and to implement that choice? Well, you can :-)

Most
functioning adults have a variety of coping skills that are used every day,
across a variety of situations. We all have things we do when we feel ourselves
getting stressed at work or irritated with our spouse. Most of us don’t need
someone to tell us to go “calm down”.
This is because we have the ability to identify what triggers us and make a decision
about how to handle it. Unfortunately individuals with Autism may not have this
ability.

I sometimes describe this to a family by
saying that when their child gets upset, they open a cabinet of options in
their mind filled with choices like “break something”, “hit my brother”, or “punch
a wall”. So saying to that child that they need to “make better choices” when
they are angry doesn’t mean anything, because they don’t KNOW any other choices
to make. So my job is to fill up that mental cabinet with multiple appropriate
choices for the child to choose from when they need to calm down.

Helping
kiddos learn coping skills can’t just be about what to do when the problem
behaviors occur. There has to be a focus on preventing the behaviors, and practicing
the strategies both when the child is calm, and when they are escalated. Use
prompting and reinforcement to teach the strategies to the child, and help them
to understand that not being in control of their emotions has consequences (disciplinary
action at school, losing privileges at home, being removed from a preferred
Community location, etc.).

Here are
some helpful strategies for teaching coping skills. This information may need
to be modified depending on the age of the individual, and cognitive ability.

Remember, practice is necessary! Use repetition & reinforcement (the two R’s!)
to teach the skills:

Strategies:

Silent counting – Tell the individual to
close their eyes and count to 10 or 15 in their head. This can provide the
individual with needed time to quietly calm down, and can give them something to focus their thoughts on.

Teach hobbies – Teach the child leisure
skills or hobbies that they can engage in when they begin to escalate and
need to “take a break”. Examples include writing in a journal, doing a
crossword puzzle, playing Solitaire, doing a puzzle, stringing beads, or folding
clothes (this can be very calming for some kiddos and it is also a helpful
life skill).

Meditative Deep Breathing – Have the
individual breathe in deeply as he or she says “Calm in”, hold the breath
for a moment, then release the breath slowly as he or she says “Anger
out”. Repeat.

Close Eyes & Imagine- Close eyes and
imagine a peaceful scene. The teacher or parent will narrate a peaceful
scene (or remain quiet if the child prefers). For example, “We’re at the
beach watching the waves go in and out…in and out…in and out. The sky is
so blue, and the sun feels good on your face”.

Progressive Muscle Relaxation – Practice
tightening and then relaxing various muscle groups from the toes all the
way up to the head. Clench/tighten the muscle group tightly, hold for 3
seconds, and release. Repeat.

Slow Stretching – Stretch arms over
head, to the side, and down to the floor for a count of 5 seconds.Repeat.

Exercise – Take a walk, do yoga
movements, run on a treadmill, do 10 jumping jacks.

Distraction – Put the child on task, by
having them complete a simple motor activity that does not require
language (even a verbal child may be unable to communicate once they are
escalated). Examples include: coloring, blowing bubbles, squeezing
objects, sorting items, filling a container with blocks, etc.

Write down/Draw a picture of how you
feel – Encourage him/her to write down words that describe how he or she
feels, or to draw a picture.

Fast/Slow – Have Him/her complete simple
motor actions very quickly, and then very slow. Examples include rubbing
hands together, squeezing thighs with palm of hands, making and releasing
fists, etc.

Whisper Only – Sit (or lay down) in a
darkened area with him/her and speak only in whispers. It may be helpful
to let the individual lay down on pillows or across a bean bag chair.

Rhythmic activities – Bouncing, rocking,
jiggling, pacing, swinging (it is important not to inadvertently teach the
child that engaging in problem behavior is how to request these
activities).

Listen to Music with Headphones – Allow him/her
to listen to calming music in a darkened room with headphones/earbuds on. It
may be helpful to also allow the individual to wear a blindfold/eyemask.

4
comments:

Just became a BT. Have little to no real experience at this moment, and I reference this site constantly. Though only half the time it's work related. Other times it's involving kiddos and even fully functioning adults, and most often myself that I come here to learn techniques and ideas for. So incredibly useful. Many of my fellow new colleagues, and you have inspired me to go back to school to learn more.